Perforated eardrum and skin graft?

[scottrish]

Hi,

I recently perforated my ear drum while diving on vacation. I didn't suffer from any of the expected symptoms, the only way I could tell was from the bubbling sensation when I tried to equalise! I stopped diving and saw a ENT specialist when I got home. This was back in the middle of September. He confirmed that there was a small perforation and suggested that I just wait and see how it heals. 4 weeks later and it was closing but not as fast as he had hoped and as of today the doctor is not optimistic about it completely closing by itself.
He suggested that I consider an operation to place a skin graft over the perforation. This apparantly is a minor op that has a high success rate (> 90%). I asked about the likelihood of being able to dive again and he suggested that there would be a greater likelihood if I got the op than if I didn't as a successful graft would result in a thicker ear drum (over the area of the perf) than I would have if I leave it to nature. We agreed to wait 3 months to see how things progress.

I'm not a frequent diver but the thought of never being able to dive again is upsetting to say the least.
Does anyone have experience of this procedure and in a position to comment on the likely outcome, with and without, the operation as regards my ability to dive after my eardrum heals?

Thanks,

Scott.

 

[DocVikingo]

Hi,

I recently perforated my ear drum while diving on vacation. I didn't suffer from any of the expected symptoms, the only way I could tell was from the bubbling sensation when I tried to equalise! I stopped diving and saw a ENT specialist when I got home. This was back in the middle of September. He confirmed that there was a small perforation and suggested that I just wait and see how it heals. 4 weeks later and it was closing but not as fast as he had hoped and as of today the doctor is not optimistic about it completely closing by itself.
He suggested that I consider an operation to place a skin graft over the perforation. This apparantly is a minor op that has a high success rate (> 90%). I asked about the likelihood of being able to dive again and he suggested that there would be a greater likelihood if I got the op than if I didn't as a successful graft would result in a thicker ear drum (over the area of the perf) than I would have if I leave it to nature. We agreed to wait 3 months to see how things progress.

I'm not a frequent diver but the thought of never being able to dive again is upsetting to say the least.Does anyone have experience of this procedure and in a position to comment on the likely outcome, with and without, the operation as regards my ability to dive after my eardrum heals?

Thanks,

Scott.

Dr. Allen Dekelboum, a recognized diving medicine ENT, has this to say about the situation:

"There is some controversy over whether to return to diving after repair of an ear drum. If the graft heals well, it is usually capable of handling the increased pressure load as one descends in the water column. It is important the eustachian tube function be normal. I have personally allowed my divers to return to diving after tympanoplasty if I felt the graft was strong and they could demonstrate to me that they were able to equalize easily. It might be also prudent to assure that the technique you use for equalizing is good."

In my admittedly limited knowledge in this area, such repairs do not always "result in a thicker ear drum (over the area of the perf) than I would have if I leave it to nature." I believe that sometimes they can be weaker. I do unequivocally know that while such repairs often are successful, there are no guarantees, that hearing may be reduced as a result and that another rupture of the ear drum can occur.

Seems to me that waiting 3 months to see how things progress is a prudent move. Obviously no diving should be undertaken until this matter is resolved.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best of luck.

DocVikingo

 

[vanished24]

Dr. Allen Dekelboum, a recognized diving medicine ENT, has this to say about the situation:

"There is some controversy over whether to return to diving after repair of an ear drum. If the graft heals well, it is usually capable of handling the increased pressure load as one descends in the water column. It is important the eustachian tube function be normal. I have personally allowed my divers to return to diving after tympanoplasty if I felt the graft was strong and they could demonstrate to me that they were able to equalize easily. It might be also prudent to assure that the technique you use for equalizing is good."

In my admittedly limited knowledge in this area, such repairs do not always "result in a thicker ear drum (over the area of the perf) than I would have if I leave it to nature." I believe that sometimes they can be weaker. I do unequivocally know that while such repairs often are successful, there are no guarantees, that hearing may be reduced as a result and that another rupture of the ear drum can occur.

Seems to me that waiting 3 months to see how things progress is a prudent move. Obviously no diving should be undertaken until this matter is resolved.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best of luck.

DocVikingo

I recently had a perforated eardrum 4mm hole no damage to the bones the tympanoplasty surgery went well. I was uncomfortable and it was hard to hear with the packing. I waited the suggested time period approx 6-8 weeks and was cleared to dive again. I was terrified that it would perf again keep praying so far so good! So I am able to dive.

 

[gert7to3]

I am not a doctor, however I have had tympanoplasty surgery, twice, in my right ear. IMHO, if your doctor thought the perforation was small enough to heal on its own, then it was probably rather small and not near anything critical. If he/she now thinks that tympanoplasty would be helpful to correct the partially healed perforation, then I would accept the advice.

The surgery is not terribly unpleasant. Since you probably have a lot of your eardrum present, the graft has a high probability of success.

Keep in mind, that even if an eardrum had successfully healed on its own, there will probably be scar tissue which could affect your hearing. A perforation could affect hearing as well.

The site of the tympanoplasty will likely be weaker than the existing eardrum. That's because the anatomical eardrum is stiffer and more fibrous.

My tympanoplasty involved replacing almost my whole eardrum. So it is more fragile and can become waterlogged. I have suffered two pinhole perforations whilst diving. I use a Pro Ear mask which permits me to keep my ears dry.

Working out proper equalization technique is critical to any further diving activities.

 

[Dan1219]

Ive been diving on a tympanoplasty fixed left ear drum (close to entire loss) since 1989. I have a great ENT. The only residual side effect is incresed wax production in my left ear. I have it cleaned once a year by my ENT and we try to guess where (which dive) the stuff he pulls out came from. Hundreds of dives later, both cold and deep, no issues at all.

However, I do use a nasal spray (ENT keeps a standing scrip for me) prior to any dive to avoid equalization pressure issues-successfully so far.

 

[Projeckt_Mayh3m]

Ive been diving on a tympanoplasty fixed left ear drum (close to entire loss) since 1989. I have a great ENT. The only residual side effect is incresed wax production in my left ear. I have it cleaned once a year by my ENT and we try to guess where (which dive) the stuff he pulls out came from. Hundreds of dives later, both cold and deep, no issues at all.

However, I do use a nasal spray (ENT keeps a standing scrip for me) prior to any dive to avoid equalization pressure issues-successfully so far.

Hi Dan.

I had tympanoplasty on my left ear drum approximately 5 weeks ago. My recovery seems to be going well. I've got my final post operation appointment with the surgeon in 2 weeks. I'm expecting him to give me the thumbs up to get my ear wet and dive again. Can you tell me how long after the surgery you waited before you first equalized? I'm a bit scared to equalize.

 

[Dan1219]

I was in the water immediately upon being cleared. My dive doc at the time (military M.D.) made it clear that the issue would be ability to clear. Started dives shallow (60 feet or less) and within 2weeks was back to complete comfort- no residual issues (psychological or physical) with no limitations. Again, I reiterate your wax production is going to increase exponentially and you will have to keep your ears clean. I still have a standing annual appointment for ear cleaning. Just completed 6 dives over 2 days with a water temp no more than 45 degrees. Depth ranged from 130-70'. No issues with clearing at all.